Community health centers juggle declines in visits

Community health centers that provide medical care to 400,000 low-income patients throughout the state are adapting to the coronavirus pandemic by shifting to telemedicine and reconfiguring the way staff offers in-person health services.

But like many hospitals and businesses throughout the state, they are facing deep financial losses during the public health emergency. Nevertheless, they continue to provide frontline medical services — from essential wellness checks such as childhood immunizations to COVID-19 screenings, officials said.

“They are the frontline helping patients get to the right place at the right time during this very difficult circumstance,” said Ken

Lalime, chief executive officer of the Cheshirebased Community Health Center Association of Connecticut. “It’s what they do all the time, but during this crisis, it becomes incredibly important.”

A network of community health centers throughout the state provides health care for about 11 percent of the state’s population by offering services on a sliding scale for those who don’t have insurance and by accepting Medicaid, Lalime said. His organization represents 16 of the 17 health centers in the state.

“We take care of the patients in need,” he said. “Anyone who shows up at the door gets serviced regardless of their ability to pay.”

The health centers were initially hit hard with extra expenses while trying to make the shift to outdoor triage tents for screenings and telemedicine services. At the same time, many also saw a 50 percent drop in the number of patients coming in for services, Lalime said.

The losses cut deep, said Michael Taylor, CEO of the Cornell Scott-Hill Health Center serving New Haven and Hamden. “We had to furlough staff,” Taylor said. “Those furloughs were effective [Wednesday]. Our visit volume declined 50 percent since the beginning of March. Needless to say, you can’t maintain a workforce with 50 percent less patients.”

The Cornell Scott-Hill Center shuttered 12 school health centers in New Haven and Hamden when schools were closed in March to help stem the spread of the virus. The dental clinic can only perform emergency procedures, and patients are fearful about in-person visits, Taylor said.

“What we’re concerned about is that they might be more ill than they think, and we want to be proactive,” he said.

The good news is that Taylor’s center already had piloted telemedicine through a grant. “We’ve been doing some form of telemedicine for a yearand-a-half,” Taylor said. “We regarded it as the future, and we didn’t want the future to be knocking at our doorsteps.”

As it became apparent that the coronavirus, which causes a respiratory infection called COVID-19, would create a spike in illnesses and deaths in Connecticut, local community health centers had to adjust with lightning speed to determine how to deliver services safely and limit transmission of the disease, providers said.

Fair Haven Community

Health Care, which serves 18,000 patients in the New Haven area, initially was beset by many of the same problems, including a decline in patients while trying to ramp up telemedicine quickly, said CEO Dr. Suzanne Lagarde.

But Lagarde said now she is concerned about meeting patient demand after some workers were furloughed due to the decline in patients, while other staff members have tested positive for COVID-19 and are out of work and still others are quarantined at home.

Fair Haven is doing about 80 percent of its work through telemedicine, and is screening those seeking in-person appointments for symptoms of COVID-19. “There is still a need for face-to-face appointments, but we are doing it at one site,” Lagarde said. “We are trying to bring only non-COVID patients there. Everyone is getting screened with a questionnaire and a temperature check. If they have symptoms, they are being sent to triage.”

The center is trying to get the word out to undocumented immigrants that they still can seek care, she said. The center also has waived fees related to COVID-19 for eligible patients. “People are fearful of coming forward, but we want them to know they can come in and be seen and cared for,” Lagarde said.

At the same time, Fair Haven has taken over the management of health care for thousands of residents of the Bella Vista apartment complex in New Haven. Fair Haven is encouraging social distancing so residents won't have to leave their apartments to seek services.